Medical Transactions, Published by the College of Physicians in London. Vol. V

f)oor bird doomed to expiate a fit of presumption by the oss of its plumes. Thus might he have been spared the torture of a feathering; and ourselves the pain, little less severe, of inflicting it. But to speak seriously, we think the honour and dignity of the College of Physicians compromised by the admission of a paper which the Editors of at least two of the three Medical Journals published in London, would, we are convinced, certainly have rejected.


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sided, leaving a constant sense of tightness across the forehead, and of " want of room within the skull." Eight months afterwards, the vision of the right eye was suddenly diminished, and at length completely lost. The left shared the same fate. In this state of blindness, the efFect of emetics was very remarkable. " In the act of vomiting, the power of vision was suddenly restored to the right eye, with a sensation as if a flash of lightening had taken place, but it remained only for the short space of an hour, the clear vision gradually subsiding to a glimmering of light, and at last becoming extinguished." The pupils were fully dilated, the retina? quite insensible. After the lapse of a year, he applied for relief of gastric derangement, signalized by uneasiness of the stomach, anorexia, and disposition to vomit. The bowels were inactive; urine copious; pulse natural; tongue palecoloured. The tightness of the forehead continued. The body was sluggish ; the intellect clear and vigorous. Medicine did not relieve the nausea : weakness and constipation ensued. Emetics were again tried. After the second, the iris regained, and preserved during life, its mobility, but vision was not restored. Impending apoplexy was averted by local abstraction of blood, and blistering. The patient became sleepy; his articulation indistinct. The mental faculties remained clear, the sense of hearing remarkably acute, to the last. Dissection.'?-'The arachnoid membrane on the upper part of the brain was considerably thickened. The ventricles contained an unusual quantity of water with a little " matter floating in it." The pituitary gland, enlarged to five times its natural size, was changed into a pulpy structure; the sella turcica proportionately enlarged. To the upper part of the gland was connected an oval tumour, large as a hen's egg, whicli occupied the site of the infundibulum, separated the optic nerves, extended into the third ventricle, and contained a thick purulent fluid. The fibres of the optic nerve were expanded, and almost destroyed, towards the tumour.
The vessels of the brain were unusually turgid. The plexus choroides was thickened, and contained some small earthy concretions.
The results of the other eleven fatal cases will be most clearly and concisely exhibited by the following None discovered in the brain or abdomen.
Effusion of blood into the ventricles of the brain.
Meningeal vessels of the brain loaded: two ounces of bloody water effused into the lateral ventricles.
A firm, thick, vascular membrane, beneath the dura mater, and enveloping the right hemisphere of the brain. The arachnoid beneath, thickened, and inclosing a gelatinous fluid. Two ounces of water in the ventricles.
Coagulable lymph and pus covering the right hemisphere of the brain, and collected between the posterior lobe and tentorium. Petrous portion of the temporal bone carious : dura mater above it detached and sloughy.
Arachnoid and pia mater opaque ; eight ounces of aqueous fluid effused between the membranes, and into the ventricles of the brain.
Ulceration in thq fore-part of the anterior lobe of each hemisphere.
Cerebral membranes loaded : Four tubercles imbedded in the right hemisphere, which was unnaturally large. One  Morbid Appearances on Dissection. A tumour anteriorly in the right hemisphere of the brain, very firm towards the centre, and compressing the right ventricle. llalf an ounce of water in the left ventricle.
A tumour on the base of the anterior lobe of the left hemisphere of the brain; the medullary substance of the hemisphere reduced to a pulpy state ; the cortical sound. Some fluid contained in the ventricles.
Right sac of the pleura containing much pus : Liver enlarged and morbid. A large cyst, inclosing pus and blood, beneath the anterior part of the corpus callosum, and projecting into the right ventricle.
Dr. Powell terminates his " gloom}' catalogue" by the narration of a case in which abstraction of blood from the temporal artery, during a dreadful paroxysm, was productive of signal benefit. His recommendation of arteriotomy in affections of the head, requiring depletion, we can, from experience, most cordially second ; and frequently have we regretted to see a less effectual operation preferred to it, from some vague and groundless apprehension of its attendant difficulties. That man, call himself what he will, is no surgeon, who would hesitate or blunder in the incision of the temporal artery.
The value of this communication is, in our view, greatly enhanced by considering the rank and situation of its writer. Fellows of the College, too commonly, like the fastidious Felloroes of the army, cherish a contempt for the drudgery of the scalpel, sublime and dignified in their own conception, as disgraceful, mean, and despicable in. ours.
Highly then are we gratified to see such zeal for the cultivation of morbid anatomy evinced by a man of Dr. Powell's character and talents. May the influence of his example among the medical students of St. Bartholomew's, be deep and extensive, as his exertions and their object are honourable ! May they be taught to consider clinic Medical Transactions. cal and anatomical observation as the two eyes of physic, each reciprocally aiding ? each imperfect without, the other; and a blind physician, like a profligate priest, as one of the deepest curses that society can foster within its bosom.
XVII, Remarks on Palpitations, and on Epilepsy. By Thomas Young, M. D. F. R. S. See.? From the wellknown effect of a watery fluid in transmitting pulsatory motions, Dr. Young attempts to explain the anomalous appearances sometimes accompanying palpitations of the heart; and which, improperly viewed, give rise to mistaken notions on the physiology and pathology of-the sanguiferous system. YVe shall select, in illustration of his doctrine, the first of two cases which he records. A middle-aged woman, after repeated attacks of acute rheumatism, was seized with palpitation of the heart, several times recurring. Violent pain about the navel succeeded.
Respiration became laborious. Dropsical effusion into the abdomen and cellular membrane repeatedly yielded to diuretics, and the pain was much relieved ; but always during the presence of it and the abdominal swelling, the complexion was yellow, the lips and nails purple. Palpitation was observed in the heart, in the rig/it hypochondriac region, and right side of the neck. The pulsation of the latter was unconnected with the stroke of the carotid artery, and not confined, Dr. Y'onng asserts, to the jugular vein. The patient could not recline on 4fce left side. She ?was once more greatly relieved by medicine; but the dropsical symptoms again shewed themselves. The palpitations of the heart, neck, and abdomen, were much diminished : the motion of the former organ, however, was fluttering; the pulse intermitting and irregular. Weakness and diarrhoea succeeded. At length, the dropsy nearly subsided, and the palpitation was, in great measure, confined to the heart. The general symptoms were again somewhat relieved by recurrence of the rheumatic affection of the joints; and the woman soon after died. On dissection, the heart was found enlarged ; the valves of the pulmonary artery so much ossified as to impede the free passage of the blood; an accumulation of fluid in the pericardium, in the right cavity of the thorax (probably about txcelve ounces), and in the ventricles of the brain : " little or none" in the left thoracic cavity ; the liver dark-coloured. Now Dr. Young, resting upon these facts, attempts to prove that the pulsatory motion, displayed on the right side of the neck and in the right hypochondrium, arose Medical Transactions. 3jg from the action of the heart, propagated by the effused fluid of the corresponding thoracic cavity to those regions. The obvious difficulty, resulting from the small quantity of that fluid, evidently inadequate to such effect, he surmounts by the supposition, that as the general dropsical symptoms had subsided, a great portion of the effused fluid might have been removed from the thoracic cavity. This argument derives, in his opinion, additional force, from the decrease of pulsation of the neck, noted on the decline of the dropsical swellings; and the absence of pulsation on the left side is explained by the immunity of the left thoracic cavity from the effusion. The inference attempted to be established is, that pulsation in the neck and hypochondrium may be regarded as " an additional nosological test applicable to the discrimination of dropsy of the chest." But to this hypothesis of Dr. Young, many and formidable objections present themselves. In the first place, the accuracy of the Doctor's premises is exceedingly suspicious: for, granting that the diminution of fluid in the right cavity of the chest were absolute fact, instead of mere conjecture as it now is, its admission must open the door to another difficulty. Twelve ounces of fluid were poured out into the right cavity of the chest, and a " little" into the left.* Now, if we allow that a considerable portion of such fluid had been taken up from the former, is it not possible, nay probable, that the latter also might have been relieved in like manner? unless Dr. Young can ingeniously contrive to exclude it from the rights and privileges of the absorbent process. And be it remembered, that, even when the heart is not "enlarged," the left pleura is always less capacious than the right. Again, whenever any fixed obstacle exists to the passage of the blood .through the pulmonary cavities of the heart, pulsation of the right cervical and hepatic regions is frequently, and without any complication of hydro-thorax, observed. This phenomenon we have been accustomed to refer to the consequent reflux of blood into the superior vena cava and * " Little or none" is a vague mode of expression, highly improper in scientific description, and unworthy of Dr. Young. Either there was fluid, or there was not. But the very expression indicates its existence. Why then was not the precise quantity correctly ascertained and specified ?
Does not Dr. Young consider percussion of the chest as a " nosological te&t"?a mean of discrimination, applicable to cases of hydrothorax ? If bo, why did he aot employ it, and state the results?

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Mcdical Transactions. right jugular,* into the inferior cava and hepatic veins, on each contraction of the cavity situated anteriorly to the obstructed orifice, in the route of circulation. In a case of cardiac Jesion, so precisely resembling that which forms the subject of our present criticism as to require no description, we ourselves, some time since, observed a similar pliEenomenon. The sonorous condition of the thorax, at first, bespoke its cavities free from effusion. Universal dropsy supervened. The sound of the chest became gradually obscure. Every other sign of hydrothorax was distinctly marked. The pulsations of the neck and hypochondrium declined as the accumulation rose.
This we attributed to the oppressed state of the heart, and its diminished powers of re-action, consequent either on the load of thoracic fluid, or on the exhaustion of the vital energies, perhaps both. No medicine would excite to activity the absorbent system. The unfortunate woman perished from suffocation. After all, it cannot be denied, that there is much ingenuity, and perhaps some truth, in the explanation of Dr. Young. All we contend for is, that anomalous pulsations of the neck and abdomen may exist, as in the case at which we have just glanced, independently of hydrothorax; and, as in the example cited by himself, admit of explication unconnected with the phaenomena of hydrostatics. Hence, in the present state of our knowledge concerning them, these pulsations cannot be legitimately regarded as a pathognomonic sign of dropsy of the chest. ? The second case is rather inimical, than otherwise, to Dr. Young's hypothesis. The cervical pulsation existed on both sides. An accumulation of serum was found in the pericardium, but not in the sacs of the pleura. The heart was considerably enlarged, species of phthisis is placed, like gastric scirrhus and thoracic aneurism, far beyond the reach of all its boasted resources.? But it is time to say something of M. Orban's plan of treatment. This consists in administering one pill, with four ounces of an acidulous drink, nine times a day.* He first derived it from the practice of a Moorish physician, of Tunis, upon one of whose patients, far gone in catarrhal phthisis, he witnessed its successful operation.
The Moor restricted the invalid to two meals a day : they consisted of boiled millet or vermicelli, without liquid. Constipation of the bowels he considered as a most auspicious symptom, which he never attempted to obviate.
Nine cases of phthisis are recorded by the French surgeon, in which this plan, with slight modifications, was instituted. Six of these are said to have been permanently cured by it.
XIX. A Case of Elepkantiasis. By Edward Roberts, M. D. 8tc.?The subject of this horrible affection was a boy, aged fourteen, by birth an American. It first attacked the head and face after exposure to rain during three successive nights, upon his voyage to England. Some slight indisposition previously suffered, the head, eye-lids, and lobes of the ears, began to enlarge, and tubercles appeared on the face. Breath offensive; urine thick; genitals shrunk ; hair fallen from the pubis and eye-brows ; sexual desire extinct. The tubercles, after landing, extended to the hands and feet. The countenance was much disfigured; lips swollen; alaj nasi enlarged, flattened, scabrous; the disease at length extending to-the throat; the gums tumid and vascular; voice weak and hoarse. The tuberculated parts differed little in colour from the rest of the skin, and were insensible. There was a troublesome itching, with issue of a sanious fluid from some parts, succeeded by a scab: on some, superficial ulceration took place; from others, a " furfuraceous scaling of the cuticle." With the exception of head-ache and total absence of perspiration,^ the lad's health was little disturbed. After the unavailing* * The pills are thus formed : Take of benzoic acid half a scruple; alum, sulphate of iron, gum arabic, each scrup. j; soot, a handful. Levigate them with water on a marble, and form them into seventy pills. Hie liquid consists of rain water, oz. xlij ; white wine vinegar, oz. vj ; refined su&ar. oz. ij. The twelve ounces of this mixture, not consumed with the pills, were administered warm during the night. M. Orban, in some cases, substituted citric for acetic acid; and always excluded the iron from the pills. 303 trial of various remedies, he got completely well under the employment of generous diet, cinchona-decoction, and small doses of submuriate of quicksilver and opium internally ; and of vapours of hot water to the face, and warm fomentations to the extremities. The cinchona was prescribed for a herpetic affection of the abdomen, complicated with fever. Diarrhoea and cough came on during recovery. The lad, after a residence of eight months, was discharged fiom St. Bartholomew's, with an " entire new countenance." XX. Case of Puejperal Fever, in which the Uterus and Spleen zver e principally affected. By Hugh Lee, M.D. See.?-A woman, aged 28, in whom a severe attack of puerperal fever, occurring on the fourth day from delivery, had been subdued by veneesection, blistering, and purging, was found, after a week of apparent convalescence, during which, however, obstinate constipation had prevailed, in a very alarming state. There was much constitutional irritation, without pain or other symptom of local affection. Abdomen painless on pressure; skin hot, but clammy; pulse rapid, small, compressible; respiration frequent, anxious, laborious; countenance jaundiced, and cheeks exhibiting the circumscribed redness of hectic; tongue foul, little thirst, urine tinged with bile, and bowels obstinately costive. Strong cathartics, and subsequently cordials, were administered in vain. The woman sunk rapidly, and died in a few hours.
On dissection, were found slight turgescence of the peritoneal vessels; sigmoid flexure of the colon inflamed, and adhering to the left altered Fallopian tube; uterus slightly inflamed externally; its vessels enlarged and turgid, internal surface exhibiting a gangrenous, irregular appearance, dark, livid, or greenish, with adherent portions of coagulated blood resembling polypi ; left ovary much diseased, vagina of a livid colour; spleen adhering to the adjacent peritonaeum ; its internal structure soft, spongy, and filled by an intimate mixture of pus and grumous blood. The two kidnies, united at their inferior extremities, " formed one continuous body of a semi-lunar form." In structure, they were healthy. The unnatural formation of these organs is illustrated by a coarse and spiritless engraving. The observations of Dr. Lee possess little interest. He thinks that the phenomena, observed on the internal surface of the uterus, did not arise from gangrene, but from decomposition of the effused blood and lymph, lie farther spe-10 2U ^24 Medical Transactions.
culates on the connexion of inflamed spleen with puerperal fever, and quotes the writings of the French Gastellier, in proof of its frequency. XXI. Observations respecting the Safety and Efficacy of the internal Use of Superacetate of Lead in Pulmonary Con sumption. By John Latham, M.D. &c.?The learned writer of this paper finds a difficulty in persuading himself that lead is " necessarily detrimental to the animal body." Indeed, he considers it destitute of the " deleterious qualities almost universally assigned to it." At least, whatever destructive properties lead itself may possess, " nothing pernicious can be charged upon it in the superacetated form and it is " agreeable to other analogies" to " suspect" that the lead, " although in itself actually poisonous, becomes innocuous by the addition of acetous (acetic) acid" These are the words of Dr. Latham ; Nuid nothing can exceed the astonishment with which we read them. Is it possible, that the President of a British College of Physicians can be ignorant of facts with which every student of medicine must be familiar? Lead, in its metallic state, is perjectly inert; and only acquires deleterious properties in its various combinations with oxygen or its compounds. However this be, Dr.
Latham recommends the superacetate to be given in " very large quantities, not only in haemorrhages, but in colliquative diarrhoeas and hectic perspirations, and more especially in that semi-purulent expectoration which too often terminates in pulmonary ulceration and consumption." He has even seen it " effect a cure," where there has been a " very copious expectoration of actual pus." He commonly prescribes it in combination with opium, and has never known mischief result from its employment.
But we would warn the young practitioner not to confide implicitly in such sweeping and unqualified statements.
The acetate of lead is indeed a valuable medicine, and may sometimes be largely administered, not only with impunity, but with excellent effect: yet, we have occasionally witnessed violent symptoms produced by the ingestion of comparatively slight doses. It is curious, that every paper contributed by Dr. Latham to this volume, has, for its main object, an eulogium on some preparation of lead. These saturnine propensities in the head of the College are surely somewhat alarming. We hope that Saturn is not its presiding deity ! XX11. A Case of Fever, attended with inordinate. Appetite. By R. P. Sattkkley, iVl. D. 8cc.?Anorexia is al-most an invariable concomitant of fever. But, in this case, the patient, a boy of sixteen, became, on the fifth day of an attack of severe typhus, ravenously hungry ; would consume at a meal, without being satiated, " a pound and a half of beef steaks, a large fowl, or a couple of rabbits and, moreover, eat many pounds of dry bread, biscuits, or fruits, during the day. The voracious appetite always began with the febrile paroxysm, and declined with it.
During the remission, he slept soundly. Restriction with respect to food produced great distress, and aggravated the febrile symptoms. Substances, the most hard and incongruous, were greedily swallowed ; and when every thing else failed, he would attack the bed-clothes, and even bite his own fingers till they bled. Digestion was unimpaired. By the assistance of strong purgatives, an enormous quantity of solid natural fajces was evacuated; but no watery stools. After thirty days, the fever declined, and the patient gradually recovered.
XXIII. Three Cases of convulsive Affeclion. By Ri chard Powell, M. D. &c.?" My object in the relation of these cases has been chiefly to check by them, the account I formerly gave of the effects of the nitrate of silver." Every one will agree with Dr. Powell, that it is " as useful to record instances of failure in the effect of remedies as of their success." The cases, desc ribed, are all those of chorea, although probably differing in source, and modified in character, by the influence of age, sex, and other circumstances of the patients. Case 1. A tailor, aged 37, suffered five years ago, a singular convulsive affection, and is said to have lost his senses during twelve days. Nitrate of silver, in doses of fourteen grains every four hours, was given for a month, and subsequently opium, aconite, arsenic, zinc, and purgatives, without effect. Camphor removed the disease. In the second attack, occurring in 1815, oil of turpentine, exhibited to the amount of one ounce, induced purging and faintness, and was succeeded by uniform and constant trembling rather than occasional decided convulsions." Belladonna, cinchona, nitrate of silver, opium, assafcetida injections, and the shower-bath, were tried in vain. The alfection again yielded to camphor, administered in doses of from ten to fifteen grains every four hours.
Case 2. A boy, aged 6, suffering a second attack ; the convulsions general, but stronger on the right side than on the left; abdomen large and painful; faeces offensive. The d ;sease was not mitigated by five grains of nitrate of silver, given every four hours; but soon yielded to repeated doses of calomel and scammony, which unloaded the bowels and restored their secretions to a.healthy state. This, Dr. Powell observes, is not the only instance in which the application of the precepts of Dr. Hamilton " has led to the cure of the disease, after the methods I am more in the habit of previously employing have failed.*' Case 3. A girl, aged 17. The origin of the convulsions attributed to terror: bowels rather slow; fajces dark. After the operation of a mercurial purgative, one ounce of oil of turpentine was given : its effects violent. Increased convulsion, delirium, vomiting, and purging, were the prelude to a calm. The menstrual flux now first shewed itself; and the convulsions gradually subsided. Nitrate of silver and the cold bath were used to expedite convalescence. Dr. Powell suggests the expediency of tr}Ting oil of turpentine in hydrophobia. This paper stands honourably distinguished by the spirit of candour in which it is written.
XXIV. Facts exemplifying the Efficacy of the Cow-pox, in preventing and mitigating the Malignity of the natural Small-pox. By George Sandeman, M. D. See. The title of this paper sufficiently illustrates its import and value. We pass on to a more fruitful and interesting subjeet.
XXV. Some Observations concerning the Fever zohich prevailed at Cambridge during the Spring of 1815. By T. Haviland, M. A. Professor of Anatomy in the University of Cambridge. XXVI. A Statement of Two Cases of Fever which occurred at Cambridge. By R. Harrison, M. D. &c.?? Every medical practitioner of this island has, doubtless, heard of the Cambridge fever, and formed his own opinions as to its source, character, and treatment. On these subjects, wide difference of sentiment unfortunately existed among the gentlemen, within whose sphere of observation the malady broke out; and remedies equally dissimilar, in many cases, distinguished their practice. Far removed from the scene of pestilence and dispute; utterly unknown to, and unconnected with, any person whose opinions may become tlie subject of criticism ; unbiassed, Consequently, by interest or prejudice, we shall minutely and dispassionately analyse the two interesting papers before us, and attempt to draw from the data afforded by them, inferences which may elucidate the origin and nature of the malady ; and tend to establish, on the sure basis of induction, a plan of treatment, as decisive as it is clearly indicated.
For the sake of perspicuit}', we shall arrange our description under the three distinct heads of History of the Disease, Pathology, and Treatment. We shall conclude with such observations as a review of the subject may suggest, and such inferences as the facts, which it exhibits, may legitimately sanction.
History. The fever first shewed itself in Cambridge, about the commencement of February, 1815. Its attacks, with few exceptions, were confined to persons below the middle age. The children of the poor were particularly obnoxious to it. No doubt of its infectious nature can exist: for Professor Haviland states, that a servant, who went home ill from Cambridge, communicated it to " nearly all" her family : it proved fatal to her father. Other instances of a similar nature have be?n reported both to the Professor and ourselves. It seems to have possessed a local origin ; for some time elapsed ere it invaded, and then only in a partial manner, the surrounding villages. Professor Haviland is " disposed to attribute it," and we conceive with perfect accuracy, " to the state of the drains and ditches which have been much neglected of late, whilst the population has greatly increased."? As a standard of description of its general characters and course, we shall select the first case detailed by the Pro- Weeding exerted no evident influence on his " banging pulse." Pathology. On inspection of the body of a gentleman, aged 19. who fell a martyr to the disease, Dr. Harrison states that the following morbid appearances were discovered : vessels of the dura mater distended with blood ; other cerebral vessels unnaturally full; a large quantity of fluid eflused between the dura and pia mater; many " blotches of blood" contained in the medullary substance of the brain ; lateral ventricles very much distended with fluid. The gall-bladder empty ; the intestinal canal much distended with flatus. Thorax not examined.* What sound and obvious lessons does this interesting dissection inculcate! Treatment. In the first and only fatal case detailed by Professor Haviland, the remedies were a purgative at first, repeated blisters, antimonials, cold applications to the head, cold affusion towards the close, wine and-light cordials. In a second case, aperients, blister to the neck, and Iteches to the temples, followed by the most signal relief and speedy recovery.?Third case. An emetic, which operated on the bowels, and leeches to the temples. The * The same dissection, at least we judge it to be so, both from the correspondence of the initials and other circumstances, is detailed somewhat differently by Professor Haviland. We have thought proper to avail ourselves of Dr. Harrison's description. The difference is not considerable. head-ache and tendency to delirium were thereby prevented or removed, and the fever continued its progress, unaccompanied by these formidable symptoms, and consequently, in great measure, divested of its dangers. The treatment, afterwards generally adopted by the Professor, was clearing the stomach and bowels by purgatives and antimonials; counteracting the determination to the head by leeches and sometimes blisters; exhibiting saline medicines and mineral acids, with which were combined, " as soon as the symptoms would admit/' the lighter preparations of cinchona. Wine was sometimes useful, but could only be borne in small quantities. The cold affusion did no good in the case first related; and in another, wherein it was accidentally used, a relapse was the consequence of its employment: but in the former, it was first had recourse to on the ttnth day ; in the latter, during a state of perspiration ! Large doses of purgatives were rather prejudicial than otherwise, by inducing intestinal torpor and flatulence. VVe question, however, whether, on the Jirst onset of the malady, they were administered in a sufficiently vigorous form and dose. Cinchona, if prescribed too early, induced considerable derangement of the bowels. The decoction and tincture were found adequate to lozo diet: afterwards, submuriate of quicksilver, hi repeated doses, opium, cinchona, blisters behind the ears, occasional purgatives, wine. About the middle of June, after a severe struggle, convalescence advanced rapidly. The blood drawn on the 18th was " very huffy" Local bleeding \*as productive of greater relief than venisection.
Such are the facts which we glean from a calm and dispassionate review of the statements of Dr. Harrison and Professor Ilaviland relative to the Cambridge fever, and they derive ample confirmation, direct or indirect, from all that we have, elsewhere, heard or read respecting it.
The inferences, which may be rigorously deduced from them, are next to be examined. These, if we mistake not, are the following : That the fever, which broke out at Cambridge, in the commencement of 1815, was inflammation of the brain, complicated with fever, either essentially typhoid, or at least, extremely prone to degenerate into typhus ; That it was, at first, of local origin, though afterwards, in many instances, propagated by infection ; and that it probably may be referred to the noxious influence of the effluvia of animal and vegetable substances in a state of decomposition ;* That its fatal issue was, for the most part, determined by the unsubdued inflammation of the cerebral organ, and consequent effusion between the membranes, or into the ventricles; but that, when this inflammation was in itself mild, or checked, or arrested by proper evacuations, the disease then commonly ran on and degenerated into absolute typhus :f That the remedies, correctly indicated in tbe first stage of the disease, were such as would speedily and effectually relieve-the increased action and turgescence of the vessels of the brain, particularly local and general abstraction of blood; but that when, from the neglect of these remedies, or some peculiarity of the fever itself, such increased action had been suffered to exhaust itself, or induced a dangerous, state of debility, and the characteristic * Some years since, we saw, in a mediral student of St. Bartholomew's, a disease precisely similar, both in its external phenomena, and in the appearances on dissection, to the first case recorded by Dr. Harrison. It was evidently induced by exposure, for several hours, to the emanations of a putrid body in the dissecting roow.
-f The third case, which we have noted as occurring in the Practice of Professor Ilaviland, will constitute a clear illustration of this fact. signs of pure typhus were developed, a plan of treatment, calculated to support the declining energies of the system, could alone be had recourse to with prospect of success.
These views will, we conceive, reconcile much of the discrepancy of opinion, much of the contradiction in practice, unfortunately exhibited by the gentlemen on whom the treatment of the Cambridge fever devolved.
Drs. Harrison and Briggs, in denying, on the one hand, the existence of all complication of typhus; and Mr.
Okes, in characterizing it, on the other, as essentially and primarily a fever of debility, appear, we think, to have erred in the opposite extremes. The views of Professor Haviland, as to the nature of the malady, are certainly by far the most correct. We wish that, in the treatment, he had evinced somewhat more of the energy and decision which signalized the practice of Dr. Harrison.
Yet, had the latter gentleman pushed the calomel more freely in the earlier stages of his second case, recovery, which seems, in a great measure, attributable to the operation of that remedy, would probably have been less wavering and protracted. In any case where effusion had decidedly taken place, mercury must evidently take the lead of the few remedies which would then constitute the physician's " forlorn hope." Lastly, we may be allowed to observe, in confirmation of the opinions just delivered on the nature of the Cambridge fever, that typhus is invariably accompanied by signs of increased action in one or other of the more" important organs* of the animal oeconomy, most frequently of the brain.
Sometimes, however, this local affection is so slightly marked as to elude the eye of the hasty and. superficial observer. But is the typhus of this country ever known to run its course, unattended by some degree of head-ach, vertigo, confusion, or stupor, more or Jess strongly marked? Does the brain of persons perishing from typhus, ever fail to exhibit traces of increased vascularity and increased action ? If the correctness of our clinical and anatomical observation may be relied on, certainly not! Struck by the close coincidence of these * What are pneumonia typhodes, typhus icterodes, and puerperal fever, but inflammation of the lungs, of the hepatic system, and of the uterus and its investing peritoneum, complicated with typhus? and are not these diseases, for the most part, dreadlully infectious ? 10 2X 332 Medical Transactions. phenomena, some able pathologists have boldly asserted that typhus fever is essentially dependent on chronic in-